Geographic disparities amongst patients with gynecologic malignancies at an urban NCI-designated cancer center

Temkin, Sarah M.; Fleming, Sean; Amrane, Selma; Schluterman, Nicholas; Terplan, Mishka

doi:10.1016/j.ygyno.2015.03.010

Cited by 39 publications

(41 citation statements)

References 26 publications

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“…Multiple studies assessing racial differences in spatial access to care, which relied on GIS-calculated travel times or distances, have yielded mixed findings. While some studies have found that blacks have longer travel times and distances (9, 10, 23), others have either found no difference by race (24, 25), or that blacks actually have shorter travel times and distances (26, 27). Our finding of racial differences between travel time measures may help to explain some of these mixed findings.…”

Section: Discussionmentioning

confidence: 97%

Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems

et al. 2017

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Background Geographic access – the travel burden required to reach medical care – is an important aspect of care. Studies, which typically rely on geographic information system (GIS) calculated travel times, have found some evidence of racial disparities in spatial access to care. However, the validity of these studies depends on the accuracy of travel times by patient race. Objectives To determine if there are racial differences when comparing patient-reported and geographic information system (GIS)-calculated travel times. Research Design Data came from the Philadelphia Area Prostate Cancer Access Study (P2 Access), a cohort study of men diagnosed with localized prostate cancer. We conducted cross-sectional analysis of 2136 men using multivariable linear mixed-effects models to examine the effect of race on differences in patient-reported and GIS-calculated travel times to urology and radiation oncology cancer providers. Results Patient-reported travel times were, on average, longer than GIS-calculated times. For urology practices, median patient-reported travel times were 12.7 minutes longer than GIS-calculated travel times for blacks vs. 7.2 minutes longer for whites. After adjusting for potential confounders, including socioeconomic status and car access, the difference was significantly greater for black patients than white patients (2.0 minutes, 95 percent confidence interval: 0.58, 3.44). Conclusion GIS-calculated travel time may underestimate access to care, especially for black patients. Future studies that use GIS-calculated travel times to examine racial disparities in spatial access to care might consider including patient-reported travel times and controlling for factors that might affect the accuracy of GIS-calculated travel times.

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Section: Discussionmentioning

confidence: 97%

Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems

et al. 2017

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“…Although a recent review of cervical cancer treatment for women from Maryland noted racial difference in treatment modalities, no impact of distance travelled for care was reported (13). The same group did, however, find that Medicare and uninsured patients with gynecologic cancer, including 34 with cervical cancer, traveled the greatest distance for care and that distance was directly correlated to completion of recommended therapy (14). In an evaluation of barriers to care for cervical cancer patients, Ramondetta et al found that lack of access to reliable transportation was associated with higher stage at time of diagnosis, but did not specifically look at distance traveled for cancer care (15).…”

Section: Discussionmentioning

confidence: 99%

Distance from a Comprehensive Cancer Center: A proxy for poor cervical cancer outcomes?

Barrington

Dilley

Landers

et al. 2016

Gynecologic Oncology

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Objective To evaluate the potential relationship between outcomes in cervical cancer patients based on distance from our Comprehensive Cancer Center (CCC). Methods A retrospective cohort study of cervical cancer patients was performed. Abstracted data included: demographics, clinicopathologic variables, treatment, and survival. Analyses both by quartiles and distance < 100 and ≥ 100 miles from our institution were performed. Data were analyzed using SAS version 9.2. Results 390 patients living a median distance of 58.1 miles (range 1.2–571 miles) from our CCC were identified. Patients were generally white (n=249), non-smokers (n=226), with Stage IB disease (n=222), squamous histology (n=295) and underwent primary surgical therapy (n=229). Patients were divided into both quartiles as well as two strata: < 100 and ≥ 100 miles for comparison. Progression-free survival (PFS) and overall survival (OS) favored patients living closer to our center with a lower median OS for patients living ≥ 100 miles (65.4vs. 99.4 months; p=0.040). Cox proportional hazard modeling noted that advanced stage was predictive of inferior PFS and OS, while other clinical covariates including age, BMI, race, smoking status and histology had a variable impact on outcomes and distance greater than 100 miles was associated with a higher risk of death (hazard ratio [HR]=1.68, 95% confidence interval [CI] 1.11–2.54). Conclusion Overall survival for patients living greater than 100 miles from our CCC was worse when compared to patients in closer proximity. Outreach efforts and utilization of navigators may help decrease the impact of geographic and racial disparities on outcomes.

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“…While this may be the case, geographic disparities in ovarian cancer care have been well documented, 6,11–13 and these are likely to remain an issue for some ovarian cancer patients. A recent study in one urban National Cancer Institute-designated cancer center showed that the farther gynecologic cancer patients were required to travel to get to treatment (those traveling above 10, but less than 50 miles), the less likely they were to complete recommended care.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study in one urban National Cancer Institute-designated cancer center showed that the farther gynecologic cancer patients were required to travel to get to treatment (those traveling above 10, but less than 50 miles), the less likely they were to complete recommended care. 13 Tele-medicine, which would allow gynecologic oncologists to consult on patient cases via phone- and/or videoconferencing, has been suggested to alleviate this disparity. 3,14 However, this method has yet to be studied for its feasibility or utility in ovarian cancer.…”

Section: Discussionmentioning

confidence: 99%

Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality

Stewart

Townsend

Puckett

et al. 2016

Journal of Women's Health

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Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions about how often they refer patients diagnosed with ovarian cancer to gynecologic oncologists, and reasons for lack of referral. We also analyzed these physicians’ knowledge of tests to help determine whether a gynecologic oncologist is needed for a planned surgery. The survey response rate was 52.2%. A total of 84% of primary care physicians (87% of family/general practitioners, 81% of internists and obstetrician/gynecologists) said they always referred patients to gynecologic oncologists for treatment. Common reasons for not always referring were patient preference or lack of gynecologic oncologists in the practice area. A total of 23% of primary care physicians had heard of the OVA1 test, which helps to determine whether gynecologic oncologist referral is needed. Although referral rates reported here are high, it is not clear whether ovarian cancer patients are actually seeing gynecologic oncologists for care. The NCCCP is undertaking several efforts to assist with this, including education of the recommendation among women and providers and assistance with treatment summaries and patient navigation toward appropriate treatment. Expansion of these efforts to all populations may help improve adherence to recommendations and reduce ovarian cancer mortality.

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Geographic disparities amongst patients with gynecologic malignancies at an urban NCI-designated cancer center

Cited by 39 publications

References 26 publications

Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems

Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems

Distance from a Comprehensive Cancer Center: A proxy for poor cervical cancer outcomes?

Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality

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